agree with other responses. There is, according to results I found increased risks for serotonin syndrome as compared to other opiods. If you are on an antidepressant discuss risks with your doctor. nucynta includes a norepinephrine reuptake inhibitor effect so be familiar with symptoms to watch for if you are taking an antidepressant like Effexor, Cymbalta--SSRI SSNRI . Apparently this can be a SIGNIFICANT problem. good luck and God bless